Maternity Exam 3
Dystocia assessment and management:
-Nursing Assessment History of risk factors Maternal frame of mind Vital signs Uterine contractions Fetal heart rate, fetal position -Nursing Management Promoting labor progress Providing physical and emotional comfort Promoting empowerment
Causes of dystocia: Problems with Passenger
-Occiput posterior position= your baby's head is down, but it is facing the mother's front instead of her back -Breech presentation= describes the fetus whose presenting part is the buttocks and/or feet -Multifetal pregnancy -Macrosomia and CPD= cephalopelvic disproportion (CPD) is when a baby's head is too large to fit through the mother's pelvis, mother needs a c-section!! (SHOULD NEVER BE ALLOWED TO HAVE A VAGINAL BIRTH AGAIN> INCREASE RISK OF RUPTURE) -Structural abnormalities
Risk factors for postpartum infection:
-Operative procedure (forceps, cesarean birth, vacuum extraction) -*History of diabetes, including gestational-onset diabetes (cortisol released may cause infection)* -Prolonged labor (more than 24 hours) -*Use of indwelling urinary catheter "CAUTI" (for c-section we ue straight Cath, comes out asap)* -Anemia (hemoglobin < 10.5 mg/dL) -*Multiple vaginal examinations during labor (we try to minimize vaginal exams to prevent bacteria from going in)* -Prolonged rupture of membranes (>24 hours) -Manual extraction of placenta -Compromised immune system (HIV positive)
Causes of dystocia: Problems with passageway
-Pelvic contraction -Obstructions in maternal birth canal
Urinary system adaptations:
-Postpartum hemorrhage could result from a FULL bladder -Full bladder--> fundus shifts to side--> massage fundus -For perineal lacerations give the perineal bottle, it dilutes acidity of urine -Decreased bladder tone due to regional anesthesia--> might need straight Cath
Risk factors for postpartum hemorrhage:
-Precipitous labor (less than 3 hours)--> cervical laceration -*Uterine atony= uterus has NO TONE--> massage fundus* -Placenta previa or abruptio placenta -Labor induction or augmentation -Operative procedures (vacuum extraction, forceps, cesarean birth) -*Retained placental fragments= inspect placenta and make sure its intact to prevent hemorrhage, do ultrasound to verify placenta is completely out* -Prolonged third stage of labor (more than 30 minutes) -Multiparity, more than three births closely spaced -Uterine overdistention (large infant, twins, hydramnios)= too much fluid, macrosomia (big baby's due to diabetic mother)
Cesarean Birth:
-Reasons: cord prolapse, uterine rupture, HIV+, breech, placenta previa and abruption, maternal age, etc. -*Classic incision: not allowed to deliver vaginally if pregnant again--> risk for uterine rupture* -*Low transverse incision: "bikini", baby can be delivered vaginally if pregnant again* -Vaginal Birth after Cesarean (VBAC): controversy related to risk of uterine rupture and hemorrhage Management -Preoperative care: NPO -Postoperative care: spinal anesthesia, SCD, incentive spirometer, early ambulation is KEY to prevent DVT, and atelectasis -up to 1 liter (1000cc) of blood loss is fine, but anything more is BAD
Thromboembolic conditions:
-Superficial thrombosis: usually confined to the saphenous vein in lower leg -Deep vein thrombosis: may cause pulmonary embolism (SOB) Pathophysiology: -venous stasis, injury to innermost layer oxblood vessel, hypercoagulation Management: -EARLY AMBULATION= prevention, bed rest, NSAID's, antiembolism stockings, anticoagulant therapy (heparin)
Vital Signs Assessment:
-Temperature: slight elevation during first 24 hours; normal afterward -Pulse: 40 to 80 bpm; puerperal bradycardia -Respirations: 16 to 20 breaths per minute -Blood pressure: within usual range -Pain: goal between 0 and 2 on pain scale Remember: Day 0--> DAY OF C-SECTION= manage pain Day 1--> AMBULATION, take out catheter
What is Dystocia?
-difficulty giving birth -diagnosed after labor has progressed for a time
Lactation:
-secretion of milk by the breasts (begins in 2nd trimester) -result of interaction of progesterone, estrogen, prolactin, and oxytocin -appears 4-5 days after childbirth -*"breast crawl" process--> skin to skin contact* = If a newborn baby is placed skin to skin on his mother's chest in the first few minutes after birth, that baby will start to maneuver toward Mom's nipple. -colostrum--> what all the baby needs first few days of life -latching on is KEY, we want mother to breastfeed baby on demand -early signs of hunger: rooting reflex, clenches fist, fusses. -late signs: crying
GI system adaptations postpartum:
-the GI system quickly returns to normal -decreased bowel tones for several days, decreased peristalsis occurs, constipation (give stool softeners) -hunger and thirst due to NPO
Partner (FOB) psychosocial adaptation:
-when partner talks--> baby turns to him -couvade syndrome -visual awareness of newborn
postpartum period (puerperium)
*Begins after the delivery of the placenta* -up to 6 weeks for vaginal delivery, up to 8 weeks for c-section -changes in all aspects of mothers life that occur during the first year following birth of child
HELPERR acronym for shoulder dystocia:
*H*: Call for HELP! *E*: evaluate for episiotomy *L*: legs- McRoberts maneuver *P*: suprapubic pressure *E*: enter- rotational maneuvers *R*: remove the posterior arm *R*: roll patient onto hands and knees (all 4's)
You're doing an assessment on a postpartum patient and notice a boggy uterus. What are your nursing interventions?
*MASSAGE THE FUNDUS* and empty bladder to prevent hemorrhage
REEDA method for assessing perineum healing:
*R*: redness -none= 0 points -within .25cm of incision bilaterally= 1 -within .5cm= 2 -beyond .5 com= 3 *E*: edema -the more swelling, the higher the score <1 cm= 1, 1-2cm= 2, >2cm= 3 *E*: ecchymosis -the more bruising, the higher the score *D*: discharge -range would be from none present to profuse -serum discharge= 1 -serosanguineous discharge= 2 -bloody, purulent discharge= 3 *A*: approximation of skin edges
Maternal Psychological Adaptation: Reva Rubin's Three Phases: - women will undergo during post partum period
*Taking-in phase:* Time immediately after birth when the client needs others to meet her needs and relives the birth process (lasts for 24 hours) - happy, sharing the news, wrap up in the delivery experience. *Taking-hold phase:* Second phase characterized by dependent and independent maternal behavior (taking control, 24-48 hours) *Letting-go phase:* Third phase in which woman reestablishes relationships with others, life revolves around baby
Postpartum danger signs:
- Fever >100.4 - Foul smelling lochia (endometritis) - Large blood clots or bleeding that saturates a peripad in an hour - Severe headache/ blurred vision (pre-eclampsia) - Calf pain with dorsiflexion of foot (DVT) - Swelling, redness, discharge at the episiotomy - Dysuria, burning, or incomplete emptying of the bladder (UTI) - SOB (pulmonary embolism) - Depression/mood swings
Ovulation and return of menstruation:
- Interplay of hormones: estrogen, progesterone, prolactin, and oxytocin -Nonlactating women: return of menstruation 7 to 9 weeks after birth -Lactating women: return dependent on breast-feeding frequency and duration; anywhere from 2 to 18 months
Teaching about postpartum blues:
- Transient emotional disturbances - Characterized by anxiety, irritability, insomnia, crying, loss of appetite, and sadness - Symptoms usually begin 2 to 4 days after childbirth and resolve by day 8 - Blues typically resolve with restorative sleep - Postpartum depression and psychosis are more serious and require professional referral
Cultural Consideration
- cultures vary in their postpartum beliefs, practices, and customs - Nurses must be open, respectful, nonjudgmental, and willing to learn about ethnically diverse populations - understating various cultures views of the postnatal periods as it related to their recovery and well-being after childbirth is important for all nurses
Musculoskeletal System Adaptation
- joints return to prepregnant state except for feet - women commonly experience fatigue and activity intolerance fro weeks after giving birth 0 abdominal muscle tone is diminished after bitch and special exercises are needed to return to normal
Risk factors for dystocia:
-*Epidural analgesia/excessive analgesia= epidural given between C4-C5, full bladder will impede fetal head to descend and will prevent the mother to feel the urge to push, straight Cath q4-6 hrs* -Multiple gestation= (twins), have c-section set up in case -Hydramnios, Maternal exhaustion, Ineffective maternal pushing technique -*Occiput posterior position= face up is very painful, usually the baby comes out face down* -Longer first stage of labor, Nulliparity, short maternal stature, Fetal birth weight over 8.8 lb, Shoulder dystocia, -Abnormal fetal presentation or position, Fetal anomalies, Maternal age over 35 years, High caffeine intake, Overweight, Gestational age over 41 weeks -*Chorioamnionitis= increased FHR*:disorder characterized by acute inflammation of the membranes and fetal portion (chorion) of the placenta -Ineffective uterine contractions, High fetal station at complete cervical dilation
Forceps or Vacuum-Assisted birth:
-Application of traction to fetal head -Indications: Prolonged second stage of labor, non-reassuring FHR pattern, failure of presenting part to fully rotate and descend, limited sensation or inability to push effectively, presumed fetal jeopardy or fetal distress, maternal heart disease, acute pulmonary edema, intrapartum infection, maternal fatigue, infection -Risk of tissue trauma to mother and newborn -*Cephalohematoma: bleeding under scalp due to tissue trauma of vacuum, risk for JAUNDICE* -Mom needs to consent -May cause lacerations, bruises -Note any signs of infection or hemorrhage and intervene immediately
Therapeutic management of labor induction:
-Cervical ripening: Misoprostol--> 25mcg ripens cervix, also treats ulcers and is used for abortions -Castor oil, hot baths, enemas, herbal agents -Sexual intercourse with breast stimulation: releases oxytocin (has calm effect), semen has prostaglandin effect--> ripens cervix -Cervical Balloon: place inside cervix and inflate with 50cc of fluid--> dilates cervix (4-5cm) -Oxytocin -Bishop score: if cervix is inducible, 5-6 score is great!
Signs of postpartum or baby blues:
-Emotional lability -Irritability -Insomnia -Typically resolves within 2 weeks (by postpartum day 10) -Usually self-limiting
Endocrine system adaptations:
-Estrogen and progesterone levels drop quickly (prolactin increases) -Placental hormones decline rapidly -Prolactin levels decline within 2 weeks if not breast-feeding progesterone levels drop and prolactin increase
Postpartum infections:
-Fever >38°C or 100.4°F after first 24 hours -Organisms usually those of normal vaginal flora (aerobic and anaerobic) -Metritis: infection/inflammation of uterus -Wound infections -Urinary tract infections -Mastitis: inflammation of the breast Management: -broad spectrum antibiotics for metritis -fluids and antibiotics for UTI -breast emptying and antibiotics for mastitis
Signs of postpartum psychosis:
-HALLUCINATIONS, PARANOIA -Surfaces within 3 weeks of giving birth -Sleep disturbances -Fatigue -Depression -Hypomania: periods of over-active and excited behavior that can have a significant impact on your day-to-day life -symptoms lasting beyond 6 weeks and worsening
Causes of dystocia: Problems with powers
-Hypertonic uterine dysfunction= inappropriately high concentrations of oxytocin (contractions lasting longer than 90 seconds every 2 minutes) -Hypotonic uterine dysfunction= give oxytocin for uterine contractions -Protracted disorders= abnormally slow cervical dilation or fetal descent during active labor -Arrest disorders= indicate the complete cessation of the progress of labor -Precipitate labor= causes lacerations, delivery in less than 3 hours since onset of labor (risk for postpartum hemorrhage)
Why is it important to make sure your postpartum patient is voiding?
-If the pt's bladder is full=the uterus will be higher (make sure patient is voiding) !!! -to prevent hemorrhage we want to EMPTY BLADDER
The 4 stages of perineal lacerations:
1st degree: first figure 8 stitch 2nd degree: vaginal line and vaginal mucosa teared 3rd degree: vaginal line, mucosa and muscle 4th degree: ALL + rectum -you would need to file an incident report--> vaginal pasty (new vagina) -pt will need ostomy because rectum cant be used--> give c-section if she gets pregnant again !!!
If a patient decides to bottle feed their baby, what do we need to educate them on in regards to adding water to the formula?
Adding water dilutes the formula or breast milk and could cause hyponatremia--> seizure precaution for baby
A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's firstaction would be to:
Administer oxygen by mask -An amniotic embolism quickly becomes a pulmonary embolism. The woman needs oxygen to compensate for the sudden blockage of blood flow through her lungs.
When can you resume sexual intercourse?
After 6 weeks
Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client?
Amniotic fluid embolism -symptoms may occur suddenly during or immediately after labor. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension.
Maternal Psychological Adaptations
Attachment: The formation of a relationship between a parent and his or her newborn through a process of physical and emotional interactions Early and sustained contact between newborns and parents is vital Nurses play a crucial role in assisting with this process of attachment Factors influencing attachment include environmental circumstances, newborn health, and quality of nursing care
Physical assessment: postpartum period
BUBBLEHE acronym!! *B*reasts = size, contour (shape; flat, inverted, or everted nipples), engorgement (feed on demand) *U*terus (height of fundus, firmness) *B*ladder (voiding, bladder emptying) *B*owels (bowel sounds, distention)= *normal for hypoactive after c-section but after 2 hrs they should return* *L*ochia (amount, color, odor) *E*pisiotomy and perineum (lacerations, hematoma) *E*xtremities (Homan sign) *E*motional status --> *professor starts with this FIRST, then begins from the top of the acronym*, open ended q's, taking in oases of postpartum
Postpartum mood disorders:
Baby blues (cry about everything) -75-80% of women experience this, and it is NORMAL -within first 2 weeks, peaks at days 4 and 5 -mild depressive symptoms, anxiety irritability, mood swings, tearfulness, increased sensitivity, fatigue Postpartum depression and psychosis -symptoms last beyond 2 weeks and are more severe and require treatment
Postpartum hemorrhage:
Blood loss: >500ml following a vaginal birth >1000ml following a c-section Causes: -*Most common: UTERINE ATONY* > this is why you need to massage to fondus -lacerations, episiotomy, retained placental fragments, uterine inversion ( don't pull the placenta can lead to this) , coagulation disorders (problem with clotting factors) , hematomas
Bonding vs attachment:
Bonding: (skin to skin) Close emotional attraction to a newborn by the parents that develops the first 30 to 60 minutes after birth Unidirectional, from parent to infant Attachment: Development of a strong affection between an infant and a significant other (mother, father, sibling, caretaker)
A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth?
Brachial plexus assessment -The nurse should identify nerve damage as a risk to the fetus in cases of shoulder dystocia
Intrauterine fetal demise (IUFD):
Loss of baby in utero after 20 weeks -Reasons: infection, trauma, cord compression, cord knot (if it gets tight the baby could die), unknown, or genetic disorders -Pt is at risk for depression! Assessment: 1. assess FHR 2. if NO FHR present= CALL DOC immediately 3. Doc will get ultrasound to confirm absence of fetal activity 4. labor induction Management: -avoid pregnant nurses to care for women who are grieving -allow family to grieve and provides support and privacy (let whoever patient wants in the room) -provide consistency= keep the same nurse with her until she's discharged
The uterus in a postpartum client should be ____________________.
MIDLINE, FIRM, and NEAR UMBILICAL
Four stages of becoming a mother (BAM):
Commitment, attachment to unborn baby, preparation for delivery and motherhood during pregnancy Acquaintance/attachment to infant, learning to care for infant, and physical restoration 2 to 6 weeks postbirth Moving toward a new normal Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months)
Subinvolution:
Incomplete involution of uterus after birth -Causes: retained placental fragments, *distended bladder*, uterine myopia, infection -Complications: hemorrhage, pelvic peritonitis, salpingitis, abscess formation salpingitis (infection of the fallopian tube)
Labor Induction vs Augmentation:
Induction - (starts labor) stimulate contractions via medical or surgical prior to onset of labor -causes: gestational diabetes, IUFD= bring pt in at 37-38 weeks to monitor Augmentation - (increases labor) enhancing ineffective contractions after labor has begun -give additional oxytocin to speed things up and strengthen contractions -Indications: prolonged gestation, prolonged PROM, gestational diabetes, cardiac disease, renal disease, chorioamnionitis, dystocia, intrauterine fetal demise, is0immunization, diabetes
Many clients experience a slight fever after birth especially during the first 24 hours. To what should the nurse attribute this elevated temperature?
Dehydration -Many women experience a slight fever (100.4° F [38° C]) during the first 24 hours after birth. This results from dehydration because of fluid loss during labor. With the replacement of fluids the temperature should return to normal after 24 hours
What is Diastasis recti:
Diastasis recti is a common condition in pregnant and postpartum people. It occurs when the rectus abdominis muscles (six-pack ab muscles) separate during pregnancy from being stretched. The separation can make a person's belly stick out or bulge months or years postpartum
The nurse observes a 2-in (5-cm) lochia stain on the perineal pad of a 1-day postpartum client. Which action should the nurse do next?
Document the lochia as scant -"Scant" would describe a 1- to 2-in (2.5- to 5-cm) lochia stain on the perineal pad, or an approximate 10-ml loss. This is a normal finding in the postpartum client
Postterm Labor:
Labor that occurs after 42 weeks gestation -Maternal risks: c-section, dystocia, birth trauma, postpartum hemorrhage, infection -Fetal risks: macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scales, post maturity syndrome, cephalopelvic disproportion Assessment -nonstress tests twice weekly --> placenta starts to get "old" and tired= no longer sufficient, oxygen probably isn't efficient -weekly cervical examinations, daily fetal movement counts Management -possible labor induction, fetal surveillance
Shoulder Dystocia:
EMERGENCY -anterior shoulder: head is out but shoulder is stuck behind pubic bone -unpredicted -baby could turn blue (head is out and cord is compressed)--> BLUE BELL to call all doctors to provide care to mom and baby -*Try to Hyperflex pt's knees to create more room (McRoberts Position)--> apply suprapubic pressure, if that doesn't work try putting pt. on all 4's to deliver baby (Gaskin Maneuver) * -may need episiotomy ( incision that is made on the pubis to allow more space to deliver the baby) -when trying to deliver posterior shoulder--> dislocate the shoulder if it doesn't work or fracture. -less than 4-5 minutes to retrieve/deliver baby -Wood's corkscrew maneuver= The posterior shoulder is rotated counterclockwise until, it becomes anterior. The anterior shoulder rotates out from under the symphysis pubis and descends during this process. The hand on the fundus is not applying fundal pressure. -LAST: cephalic Zavanelli maneuver--> immediate c-section= Zavanelli maneuver is performed when the practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean birth -contraindications: fundal pressure because it makes the dystocia worse -complications: fetal hypoxia, brachial plexus injuries xxx fundal pressure (NEVER APPLY IN A SHOULDER DYSTOCIA) xxx
This postpartum infection is the most common infection affecting the lining of the uterus; some causes of which are due to multiple vagina exams, obstetric trauma and prolong labor proceedings cesarean birth.
Endometritis
TRUE OR FALSE An amnioinfusion is appropriate for a pregnant woman experiencing a prolonged second stage of labor
FALSE -a forceps or vacuum assisted birth would be indicated for a prolonged second stage of labor
TRUE OR FALSE A woman who is not breast-feeding should increase her daily caloric intake by approximately 500 calories
FALSE -breast feeding woman should do this
TRUE OR FALSE The drop in maternal blood volume after birth leads to a similar drop in hematocrit.
FALSE -despite the decrease in blood volume, the hematocrit level remains relatively stable and may even increase, reflecting the predominant loss of plasma
TRUE OR FALSE Oxytocin is an important agent used to ripen the cervix for labor induction
FALSE -oxytocin is used to INDUCE or AUGMENT labor once the cervix is ripe
TRUE OR FALSE After birth, the cervix returns to its prevaginal delivery birth shape.
FALSE -the cervix closes after delivery but never regains its pre-vaginal delivery birth appearance, it appears as a jagged slit-like opening
Typical assessments in postpartum period:
For vaginal: During the first hour: every 15 minutes During the second hour: every 30 minutes During the first 24 hours: every 4 hours After 24 hours: every hour C-section: Every 15 minutes during the first 1-2 hrs Every 30 minutes the 3rd hr First 24 hrs: every 4 hrs
Pathophysiology of Postpartum Hemorrhage: The "Four T's"
GOOD SATA *Tone*: uterine atony, distended bladder *Tissue*: retained placenta and clots *Trauma*: vaginal, cervical, or uterine injury *Thrombin*: coagulopathy (preexisting or acquired)
Amnioinfusion:
GOOD SATA Method in which isotonic fluid is instilled into the uterine cavity. It is primarily used as a treatment in order to correct fetal heart rate changes caused by umbilical cord compression -Indications: variable decelerations, oligohydramnios (due to placenta insufficiency/ cord compression), post maturity or rupture of membranes, preterm labor with PROM, thick meconium fluid (yellowish-greenish fluid--> to clean out, suction baby to avoid meconium aspiration, this causes fetal distress) -possible c-section > Severse variables decelerations due to cord compression > Oligohydramnio due to placental insufficiency > post maturity or rupture of membranes > preterm labor with premature rupture of membranes > thick meconium fluid
Which drug would the nurse expect to administer to a postpartum woman with deep vein thrombosis?
Heparin
What position is considered the "labor position"?
Lithotomy (hold legs up)
Nursing Management of Postpartum Hemorrhage:
Management: -Fundal massage, pad count -Administration of uterotonic drugs -fluid administration -monitor s+s of shock -emergency measures if DIC occurs Uterotonics: (manages uterine atony) 1. Methylergonovine (Methegene): causes increase in BP= contraindicated in pt's with HTN, preeclampsia 2. Carboprost (hemabeyt): contraindicated in asthma and pulmonary edema= COPD, ARDS 3. Oxytocin (IV) : for PPH, water intoxication 4. Misoprostol: for PPH rectally= increases temperature - Tranexamic acid (TXA): to treat heavy PPH - If all meds fail --> try B Lynch, or ligation of uterine arteries - If all FAILS (and meds)= give 500cc fluid in BAKRI balloon---> if this fails--> HYSTERECTOMY
Uterine Rupture:
OBSTETRIC EMERGENCY -onset marked by SUDDEN marked by >*fetal bradycardia*, shoulder pain, contractions stop (soft uterus) -if mom had prior scars (from prior c-section), isthmus of uterus ruptures -urgent c-section !!
Amniotic Fluid Embolism:
OBSTETRIC EMERGENCY -sudden onset of hypotension, hypoxia and coagulopathy due to breakage in barrier b/t maternal circulation and amniotic fluid, when woman breaks her water, autopsy confirms death Assessment -difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest Management -maintain oxygenation, correct coagulopathy
Umbilical cord prolapse:
OBSTETRIC EMERGENCY C-SECTION -partial or total occlusion with rapid fetal deterioration--> the umbilical cord is past the fetus head, *fetal head is compressing the cord* --> cord compression Assessment -FHR, color of fluid if membranes ruptured Management 1. Press emergency bell 2. Place in trendelenburg --> head down (or knee chest) -OR take sterile gauze and apply perineal pressure (not pushing!)
Placental Abruption:
Obstetric emergency involving premature separation of placenta -*D*: dark red vaginal bleeding -*E*: extended fundal height -*T*: tender uterus -*A*: abdominal pain -*C*: concealed bleeding (internal) -*H*: hard abdomen (rigid) -*E*: experience DIC--> thromboplastin into moms circulation--> formation of small micro embolism--> block blood vessels/flow to major organs -*D*: distress fetus/baby (fetal DECELERATION) -Main risk factor: MATERNAL HTN and cocaine users
Cardiovascular System Adaption
Post everything will be going down. - blood volume and cardiac output - hematocrit level - pulse and BP - Coagualtion factors - Red blood cell production
The nurse cared for a client who gave birth. The duration of labor from the onset of contractions until the birth of the baby was 2 hours. How will the nurse document the client's labor in the health record?
Precipitous labor -A labor that is less than 3 hours in duration is a precipitous labor. Prolonged labor, also known as failure to progress, occurs when labor lasts for approximately 20 hours or more in a first-time mother. Prodromal labor is labor that starts and stops before fully active labor begins. The contractions are real, but they come and go, and labor does not progress. False labor is intermittent nonproductive or practice contractions
Engorgement:
Process of swelling of the breast tissue due to an increase in blood and lymph supply as a precursor to lactation. -warm showers and compresses before feeding, cold compresses between feedings (if breast feeding) -bottle feeding woman (lactation suppression): wear tight supportive sports bra, ice packs, avoid breast stimulation, back against warm water in shower to CONSTRICT milk -*mothers who are not breast feeding can apply cold cabbage leaves to breast (dries milk)*
Causes of postpartum diuresis:
REMEMBER THIS IS NORMAL!! (diaphoresis is also common for about a week postpartum) -Large amounts of intravenous fluids given during labor -Decreasing antidiuretic effect of oxytocin as its level declines -Buildup and retention of extra fluids during pregnancy -Decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production
Preterm Labor:
Regular uterine contractions with cervical effacement and dilation occurring between 20 and 37 weeks gestation -one of the most common obstetric complications -risk factors: infection -contraction pattern: 4 contractions every 20 minutes or 8 contractions in 1 hours
Which of the following assessment findings would lead the nurse to suspect an amniotic fluid embolism?
Respiratory distress -acute onset of respiratory distress and hypotension indicate amniotic fluid embolism
The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team?
Sudden shortness of breath -sudden shortness of breath can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken
TRUE OR FALSE During the first 24 hrs postpartum, a slight elevation in temperature is considered normal
TRUE
TRUE OR FALSE Postpartum psychosis is the most severe form of postpartum affective disorder
TRUE
Tocolytic drugs for Preterm labor:
Tocolytic drugs are used to relax the uterus in preterm labor -Bethamethasone: steroid given to mom 1 dose q24 hrs x2 for fetal lung maturity -Nifedipine: CCB tocolytic agent (for blood pressure- used for the managment of preterm labor) -Mg+ Sulfate: agent that relaxes the uterus and prevent dilation -Terbutaline: relaxes uterus= given before external version -Indomethacin: not after 34 wks--> causes premature closure of ductus arterioles -Antibiotic prophylaxis for women with group B streptococcus
_____________________ is the most common cause of postpartum hemorrhage.
UTERINE ATONY
A nurse finds the uterus of a postpartum woman to be boggy and somewhat relaxed. This a sign of which condition?
Uterine atony -The uterus in a postpartum client should be midline and firm. A boggy or relaxed uterus signifies uterine atony, which can predispose the woman to hemorrhage
A G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication?
Uterine rupture
Reproductive system adaptations postpartum:
Uterus: -*Involution=descends 1 cm a day to pelvis*, contains contraction of muscle fibers catabolism, regeneration of uterine epithelium, shrinks to original size, breastfeeding is said to help involution -Lochia (vaginal discharge): rubra (day 1-3) bright red little heavier then regular period , serosa (day 4-10) pinkish color , alba (to day 21, cream discharge) ___ vaginal birth will have more lochia then a c-section___ -Afterpains (due to involution): *secretion of oxytocin stimulates uterine contraction and causes the woman to experience afterpains* Cervix: closure; now appearing as jagged slit-like opening ( after you gave brith ) Vagina: eventual thickening and return of rugae Perineum: -If swollen--> ice pack first 24 hrs -Sitz bath--> provides healing, post 24 hrs -Perineal bottle--> to clean after using bathroom to prevent infection
The importance of a "memory box" at hospitals:
When women lose their baby they are provided with a memory box that include footprints, lock of hair, pictures, baby blanket, etc. Ultimately this helps with closure for the mother
Is it normal for a postpartum woman to experience a gush of blood when they get up for the FIRST time?
YES, this is completely normal for the FIRST TIME, due to gravity -it is abnormal if they experience this gush of blood AFTER the first time
For the woman who is not breast-feeding her newborn, which measure would be most appropriate to relieve engorgement? a. Warm showers b. Nipple stimulation c. Ice to the breasts d. Manually expressing milk
c. ice to the breasts
During a routine assessment the nurse notes the postpartum client is tachycardic. What is a possible cause of tachycardia?
delayed hemorrhage
Three-Stage Role Development Process for Dads/Partners:
expectations reality transition to mastery
At 31 weeks' gestation, a 37-year-old client with a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3 to 4 cm. Which interactions should the nurse prepare to assist with?
hospitalization, tocolytic, and corticosteroids -At 31 weeks' gestation, the goal would be to maintain the pregnancy as long as possible if the client and fetus are tolerating the continuation of the pregnancy
A nursing instructor is teaching students about fetal presentations during birth. The mostcommon cause for increased incidence of shoulder dystocia is:
increasing birth weight
A new mother who is breastfeeding reports that her right breast is very hard, tender, and painful. Upon examination the nurse notices several nodules and the breast feels very warm to the touch. What do these findings indicate to the nurse?
mastitis
What is Puerperium?
period after delivery of placenta/childbirth, lasting 6 weeks, "fourth trimester" -during which the mother's reproductive organs return to their original nonpregnant condition
Causes of dystocia: Problems with psyche
psychological distress
A client with a pendulous abdomen and uterine fibroids (uterine myomas) has just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman?
transverse lie -a transverse lie, in which the fetus is more horizontal than vertical, occurs in the following instances: women with pendulous abdomens; uterine fibroids (uterine myomas) that obstruct the lower uterine segment; contraction of the pelvic brim; congenital abnormalities of the uterus; or hydramnios