NUR 220 TEST THREE
Spinal block/Intrathecal - where is it injected? When can it be used? When does it start working? how long does it last?
-Injected into spinal fluid -Injected late in 2nd stage or for scheduled C/S -Onset is quick -Lasts 18-24 hours (depending on meds used)
You are a nurse on the OB unit and your patient experienced shoulder dystocia during birth. How would you properly document this?
"1210 shoulder dystocia called by Dr. Dick. McRoberts maneuver immediately implemented and suprapubic pressure applied by Kathy, RN" "1215 infants shoulder and body delivered"
How would you prep your client for a C/S?
-IV insertion -Foley insertion -Consent -Needs lots of emotional support
Precipitate Labor
"Powers work too well" -Labor less than or = 3 hours before birth -High intensity uterine contractions occuring in a short period of time
Explain what fetal attitude is and what are the normal attitudes of a fetus?
(I remember this one by thinking of someone having an attitude..they have their head cocked to the side, hands on hips, and duck lips out) -The posture of the body with reference to the limbs (Flexion or extension of the body and extremities) NORMAL ATTITUDE OF FETUS -Moderate flexion of head -Flexion of arms on chest -Flexion of legs on abdomen
Hypotonic Uterine Dysfunction Treatment
**CPD AND MALPOSITIONS = COMMON CAUSES** -US OR XRAY TO RULE OUT CPD -ASSESS FHR AND PATTERN -ASSESS AMNIOTIC FLUID (IF RUPTURED) -ASSESS MATERNAL WELL BEING IF ABOVE NORMAL -MAY AMBULATE -HYDROTHERAPY -ROM -PITOCIN AUGMENTATION OR AMNIOTOMY -C/S IF ABOVEIS NOT EFFECTIVE TO INITIATE EFFECTIVE UTERINE CONTRACTIONS
Since true signs of labor cause uterine contractions to change, explain in what ways that they DO change?
- UC are regular and progressive -Increase in frequency, duration and intensity -The pain is in the back and radiates around to the abdomen
Amnioinfusion - how is it performed, what is put back into the uterus, and how does this improve the fetal environment?
-Volume of warmed, sterile NS or LR is instilled into uterus VIA IUPC -Used when oligohydramnios is present or thick meconium -Improves fetal oxygenation (cushions the cord)
When taking Clomid to induce ovulation, How much and when should it be taken? When should intercourse happen? Any side effects?
-Women should take 100mg on days 5-9 -Intercourse every other day for 1 week, beginning 5 days after last dose SIDE EFFECTS -Visual disturbances -Hot flashes -Abdominal bloating/distention -N/V
At what station are the ischial spines?
-ZERO STATION
What are the 5 critical factors in labor, or the 5 "P's of labor"?
1- Passage - (Vaginal canal, pelvis) 2-Passenger - (baby, placenta) 3-Position - (Position baby is in [[Lie,presentation, attitude]] ) 4-Powers - (Uterine contractions, abdominal muscles) 5-Psychological Response - (Influence of hormones, frequency, duration, intensity, resting tone)
Two measures to relieve back pain
1. Counter pressure (heel of hand or fist to sacrum) 2.Heat/cold application
Your patient's BISHOP SCORE is 9 - what does this mean?
A score of 8 or > = FAVORABLE TO LABOR -The Bishop Score is to assess cervical readiness -5 areas are assessed with a score of 0, 1, or 2 for each **IF SCORE IS LESS THAN 6 = CERVICAL RIPENING AGENT SHOUD BE USED PRIOR**
During the assessment of a woman in labor, the nurse explains that certain landmarks are used to determine the progress of the birth. The nurse identifies which area as one of these landmarks? a) Ischial spine b) ischial tuberosity c) pubic symphysis d) cervical OS
A) Ischial spine - ischial spine can be palpated about a finger width deep to determine how far down the fetus has moved.
In which situation would the nurse anticipate client admission to the L&D unit? (SELECT ALL THAT APPLY) a) Client is experiencing regular contractions every 5 mins b) The nurse notes that the cervix is thinned and is 7 cm dilated c) Client reports a burst if energy and completion of nursery d) There is a documented pelvic change from the last visit e) Fetal kicks noticed by mom frequently throughout the day f) The client reports a gush of fluid from the perineal region
A) client experiencing regular contractions every 5 mins B) Nurse notes that cervix is thinned and is 7 cm dilated C) Client reports burst of energy and completion of nursery (NESTING) D) Documented pelvic change from the last visit F) Client reports a gush of fluid from the perineal region
When should you notify HCP when taking combined oral contraceptives ??
A: ABD pain (liver/gallbladder) C: Chest pain (P.E) H: Headache (HTN) E: Eye disturbance (HTN) S: Severe leg pain (DVT)
Above the ischial spines is negative, and below the ischial spines is positive - how would you document this?
ABOVE -3 BELOW +3
The newborn is exclusively breastfed. If he loses more than 10% of his birth weight (7 pounds, 12 oz), he will be supplemented expressed breast milk and/or formula. The nurse is aware that if he loses more than ______________ounces, supplementation must be initiated.
ANSWER: 12.4 oz 7LB X 16 oz = 112 oz + 12 oz = 124 X 0.10 = 12.4 oz
How many mU/mL is present in the following solution? 20 units of pitocin 500 mL of LR
ANSWER: 40mU/mL
Double footling breech need to know information:
As long as the fetal heart rate is stable and no physical evidence of a prolapsed cord is evident, management may be expectant while awaiting full cervical dilation
Breech presentation need to know info:
Assisted vaginal breech delivery (AVBD) - no downward or outward traction is applied to the fetus until the umbilicus has been reached
When asked if douching is appropriate, how should the nurse respond? a) "douching adds to the cervical mucus plug and aids in bacteria prevention" b) "douching is associated with susceptibility to infection" c) "Douching is appropriate during your menstrual cycle only" d) "scented douches are associated with relief of vaginal irritation"
B) "douching is associated with susceptibility to infection" - douching washes away the natural cervical mucus plug and changes the vaginal flora which increases suseptibility to infection
A couple has been using a diaphragm for contraception. Which of the following statements indicates that they are using it correctly? a) "we use vasoline around the tip to help with insertion" b) "I wash the diaphragm each time and hold it up to the light to look for any holes" c) "I take the diaphragm out 1 hour after intercourse because it feels funny" d) "i douche right away after intercourse"
B) "i wash the diaphragm each time and hold it up to the light to look for any holes" - This is correct - No vasoline on the condom, only water-soluable lubricant should be used, Diaphragm should be left in for 6 hours after intercourse, and NO DOUCHING!
The nursing student correctly identifies the most desirable fetal position to promote an easy birth as which position? a) Breech b) Occiput anterior c) Face and brow d) Shoulder
B) Occiput anterior - this is the best position because baby's head is down facing mom's back (their back is towards the front of mom's tummy) - this is most favorable because it allows baby to move more easily through the pelvis during birth
The nursing student is learning about normal labor . The teacher reviews cardinal movements of labor and determines the instructor has been effective when the student correctly states the order of the cardinal movements as which of the following? a) internal rotation, descent, flexion, extension, external rotation, expulsion b) descent, flexion, external rotation, internal rotation, extension, expulsion c) descent, flexion, internal rotation, expansion, external rotation, expulsion d) internal rotation, flexion, entension, descent, enternal rotation, expulsion
C) Descent, flexion, internal rotation, expansion, external rotation, expulsion
The presenting part is palpable at 2 cm below the ischial spines. How would the nurse document the finding? a) U2 b) 2U c) -2 station d) +2 station
D) +2 station - since the ischial spines are zero and the head, or presenting part of the baby, is 2 cm below the ischial spines, it would be +2 station
Upon reviewing the patient's chart, which piece of data would suggest to the nurse that the doctor may diagnose the patient with endometriosis? a) ovarian pain and dysuria b) back discomfort and dysphagia c) vaginal discharge and dysmenorrhea d) pelvic cramping and dyspareunia
D) pelvic cramping and dyspareunia - Pelvic cramping and painful sexual intercourse are two signs that the patient is dealing with endometriosis
How would you protect your RN license during a FAVD?
DOCUMENT WELL -How many times forcepts applied to head -What time applied to head -What type of forceps
When looking at Cynthia's contractions, you are paying attention to the duration, frequency, intensity and resting tone. Explain when each begins and ends?
DURATION -Beginning to end of one contraction FREQUENCY -Beginning of one contraction to the beginning ov the next contraction INTENSITY -Strength of contraction at peak (ACME) -Measured accurately with intrauterine pressure catheter RESTING TONE -Tone of muscle inbetween contractions
True signs of labor - Effacement and Dilation - explain each ! :)
Effacement (cervix is shortening in length) -Thinning of the cervix -Muscles of upper uterine segment shorten -Drawing upward of the internal OS and cervical canal -Described in terms of percentages (0-100%) Dilation -Progressive enlargement or widening of cervical opening and canal -Due to fetal axis pressure and hydrostatic pressure of fetal membranes -Diameter increases <1 to 10 cm -Completely dilated cervix = NO LONGER PALPABLE STATION
What is engagement, how is it determined, and what does it confirm?
Engagement -The largest diameter of the presenting part reaches or passes through the pelvic inlet Determined -By vaginal exam Confirms -Adequacy of pelvic inlet ONLY
Cord prolapse nursing management
FIRST SIGNS -Fetal bradycardia -Recurrant variable decels MAJOR GOAL = RELIEVE PRESSURE OFF CORD! 1. gentle upward digital pressure on fetal presenting part 2. Position changes if possible (knee chest position/genupectoral position; trendelenburg position) 3. Assist with C/S 4. Cord exposed to room air - warm sterile saline compresses
What is fetal lie and lets talk about the different types....
Fetal lie - relationship of fetus' long axis (cephalocaudal axis) to the mother's long axis (spine) TYPES: 1. Longitudinal (Vertical) lie -Cephalocaudal axis of fetus is PARALLEL TO MOM'S AXIS OR SPINE >>>>> II 2. Transverse lie -Cephalocaudal axis of fetus is perpendicular to mom's axis >>>>>>> + 3. Oblique lie -Diagonal to mom's axis >>>> \
I'm going to show you pictures of fetal monitoring and I want you to write down what you think the answer is. I will add the answers in down at the bottom after you've gone through all of these. Look at what's going on in the top portion which is the fetus..that's the answer I'm looking for.
Good luck! :) PS- She will actually have you type in what you think is going on in the slide, not choose from multiple choice answers so I'm helping you out here.
Endometriosis surgical treatment options
LAPAROSCOPY -remove growths and scar tissue -destroy growth with intense heat -Save as much healthy tissue as possible LAPAROTOMY -last resort; very invasive -Abdominal incision -Longer recovery (8weeks) HYSTERECTOMY -Removal of uterus OOPHORECTOMY -Removal of ovaries SALPINGECTOMY -removal of fallopian tubes (ONLY DONE IF TUBES ARE SEVERELY DAMAGED)
Fetal occiput is directed towards the mother's left, anterior side describes what fetal position?
LOA - Left Occiput Anterior
Fetal occiput is directed towards the mother's left side describes what fetal position?
LOT - Left Occiput Transverse
Maternal and fetal complications due to shoulder dystocia
MATERNAL -Bladder injury -Cervical, vaginal or perineal lacerations -Spontaneous separation of the symphysis -Uterine rupture -Uterine atony and postpartum hemorrhage FETAL -FXs of the humerus and clavicle -Edema, intracranial hemorrhage, Erb's palsy -Caput succedaneum -Asphyxia -Death
Post term pregnancy maternal and fetal risks
MATERNAL -C/S (LGA) -Dystocia -Birth trauma -PP hemorrhage FETAL -Macrosomnia -Shoulder dystocia -CPD -RDS -Meconium aspiration -Fetal hypoxia
Breech presentation maternal and fetal risks
MATERNAL -Hemorrhage -Trauma FETAL -Trauma -Meconium fluid
Possible complications from precipitate labor
MATERNAL -Lacerations -Uterine rupture FETAL -Head trauma -Nerve damage -Hypoxia
Multifetal gestation maternal and fetal risks
MATERNAL -Postpartum hemorrhage -HTN -Hydramnios (Excessive fluid) -Antepartal bleeding -Preterm labor FETAL -Prematurity -RDS -Birth asphyxia -Congenital anomalies
Endometriosis Medical treatment options
MEDROXYPROGESTERONE ACETATE IM (DEPO) -Atrophy of endometrial tissue GONADOTROPIN RELEASING HORMONE AGONIST (NAFERELIN ACETATE AND LUPRON) -Better tolerated than Danazol -Suppresses menstrual cycle DANAZOL -Hormone -Inhibits growth of endometrium and supresses ovulation -Menstruation ceases or decreases -Pain reliver -Short term therapy -SIDE EFFECTS: OILY SKIN, TIRED, DECREASED BREAST SIZE, AND HOT FLASHES
What can reduce sperm motility and quality?
MOTILITY -Depressed by cigarette smoking QUALITY -Use of certain Meds: CA CHANNEL BLOCKERS, PROPRANOLOL ****
The powers of labor have a primary and secondary force. What are they?
PRIMARY -Uterine muscular contractions (causes complete effacement of cervix) SECONDARY -Abdominal muscles (used to push during second stage of labor, adds to the primary force, AKA "bearing down"
What are the causes of labor dystocia?
PROBLEM WITH THE P'S OF LABOR -Powers (Contractions) -Passenger (Presentation, position, fetal development) -Passageway (Maternal bony pelvis or birth canal) -Psyche (Maternal stress)
Explain how each hormone influences the body?
PROGESTERONE -Causes relaxation of smooth muscle -Decreases closer to delivery ESTROGEN -Causes stimulation of uterine muscle contractions -Increases closer to delivery PROSTAGLANDINS -Causes connective tissue to loosen -Permits softening, thinning, and opening of cervix
Explain the psychological responses and what are they influenced by?
PSYCHOLOGICAL RESPONSES -Readiness for transition into new role -Concerns about performance during labor -Concerns about pain INFLUENCED BY -Coping mechanisms -Support systems -Provider/procedure
You have been pregnant for 35 weeks and are starting to experience premonitory signs of labor. Explain what premonitory is and give examples of the signs
Premonitory -Changes occuring in the body for birth preparation suggesting that labor is near SIGNS: Lightening -Fetus drops -Presenting part descends into the true pelvis -Uterus sinks downward and forward -Occurs about 2 weeks before term Surge of Energy -Usually occurs 24-48 hours before birth -Energy to clean and put things in order -"Nesting" Braxton-hicks contractions -Frequent but irregular and intermittent -Become stronger -Felt in the abdominal and groin -THESE HELP MOVE THE CERVIX FROM A POSTERIOR POSITION TO AN ANTERIOR POSITION Cervical changes -Cervix becomes soft (ripens) -May begin to dilate -Can occur 1 month up to 1 hour, before actual labor begins Spontaneous rupture of membranes -Membranes may rupture spontaneously -LABOR WITHIN 24 HOURS Bloody Show -Mucus plug expelled (within 24-48 hours - labor is imminent) -Brownish or pink-tinged cervical mucus
What are the risks of macrosomnia and what type of labor would mom normally have in this case?
RISKS -Maternal hemorrhage -Shoulder dystocia -Low APGARS -Dynfunctional labor -Lacerations -fetal injuries -Fetal hypoxia **A C/S is usally done in this case and scheduled before onset of labor
I STRONGLY ENCOURAGE YOU TO LOOK UP PICTURES OF THESE DIFFERENT POSITIONS, PRESENTATIONS, LIE, ETC ETC SO THAT YOU CAN GET AN IDEA IN YOUR HEAD ABOUT WHAT WE'RE EVEN TALKING ABOUT
SERIOUSLY.. LOOK UP THE F'n PICTURES.
Nursing interventions for Variable decelerations...
THINK OF CORD COMPRESSION -Position change -Vag exam -o2!
Interventions for Early Decelerations
THINK OF HEAD COMPRESSION AND DECREASED O2 -Position change -Vag exam
Interventions for LATE DECELERATIONS
THINK OF PLACENTA -STOP PITOCIN -Left Lateral position -o2 -IVF bolus -Call MD and prepare for C/S!
What is the difference between true signs of labor and false signs of labors?
True labor -Changes the cervix -Uterine contractions do NOT go away with ambulation and movement False labor -Does NOT change the cervix -Uterine contractions go away with ambulation
The nurse is monitoring a client who gave birth 1 hour ago. Which finding should the nurse prioritize and report immediately for an intervention? a) mother has not voided yet b) mother's pulse is 104 and BP is 92/51 c) placenta separated 15 mins after birth d) mom has not held the baby since delivery
b) Mother's pulse is 104 and BP is 92/51 -- the mother's BP is extremely low. Could be severe bleeding or something else going on.
A pregnant client in her 1st trimester of pregnancy reports spontaneous, irregular, painless contractions. What does this indicate? a) Preterm labor b) Infection of the GI tract c) Braxton-hicks contractions d) Round ligament pain
c) Braxton-hicks contractions - they are not signs of true labor so they are spontaneous, irregular, and painless.
Factors of passageway the affect the labor process?
-Type and size of pelvis -Ability of cervix to dilate -Ability of vagina to distend -Ability of perineum to distend
Condom education for males!
-USE WATER-SOLUBLE LUBRICANT!!!! -Apply over erect penis -Leave a space at the tip for sperm -Made of latex, polyurethane or natural membrane
Hypertonic Uterine Dysfunction
-Uterus never fully relaxes between uterine contractions -Placental perfusion becomes compromised CONTRACTIONS -Uncoordinated and erratic -Frequency = increasing -Intensity = painful -Resting tone = increasing **CAUSES MATERNAL EXHAUSTION AND FETAL HYPOXIA**
What is VEAL CHOP and why do I need to know this?
-VEAL CHOP is an acronym that is going to help you figure out what you need to do during fetal monitoring.. V: variable C: cord (compression) E: early H: head (compression) A: acceleration O: okay! L: late P: placenta So for example...if you have a late decleration you can see that across from the word "late" is "placenta" which tells you that you could have an issue with your placenta not being in the correct spot and it's causing issues. You're welcome.
ANSWERS...........
1. Acceleration 2. Late decelerations 3. Non Stress Test REACTIVE 4. Moderate Variability 5. Marked Variability 6. Non Stress Test NON REACTIVE 7. Variable Decelerations 8. Minimal Variability 9. Absent Variability 10. Early Decelerations
Your patient is experiencing spontaneous rupture of membranes (SROM) - What interventions would you perform as a nurse?
1. Assess FHR immediately after ROM (ROM = DANGER of prolapsed cord if engagement has NOT occured) 2. Nitrazine-paper that turns blue if in contact with amniotic fluid (Test to see if the liquid is urine or amniotic fluid)
Presentation types.....give me 3!
1. Cephalic -vertex - Occiput (back of head) is presenting part -military- top of head is presenting part -brow- Sinciput (front of scull) is presenting part -face- face/mentum(chin) is presenting part 2. Breech -complete - knees and hip both down near butt -Frank- butt is down - legs straight up near head -footling- feet are presenting part 3. Shoulder -AKA Transverse lie
Fetal presentations - Explain all 4 :)
1. Cephalic (VERTEX) presentation -Occiput -"O" 2. Face presentation -Mentum (CHIN) -"M" 3. Breech presentation -Sacrum (BOOTY) -"S" 4. Shoulder presentation -Acromion process of scapula -"AP"
Leopold's maneuver is used to determine what 5 things and in which order?
1. Fetal presentation 2. Fetal position 3. Fetal lie 4. Fetal engagement 5. Fetal attitude
Shoulder Dystocia management
1. Increasing number of occurrences (fetal macrosomnia) 2. Maternal position changes (hands and knees, squatting, lateral recumbent) 3. Suprapubic pressure to anterior shoulder 4. McRoberts Maneuver (knees on ABD/chest, legs flexed) 5.Extra personnel 6. Maneuvers to relieve shoulder dystocia
FETAL POSITION - There are four landmarks related to four imaginary quadrants of the pelvis..what are they?
1. Left anterior 2. Right anterior 3. Left posterior 4. Right posterior
You're the nurse on an OB unit and have just received a patient from the ED. Your patient is in active labor - You know that you need to perform an assessment on four main things - What areas would you assess during your patient's labor/birth process?
1. Maternal Vital Signs: Temp, BP, Pulse, RR, ROM, UC 2. Prenatal Record: ID risk factors of fetal compromise 3. Vaginal Exam: Ensure that there's no vaginal bleeding 4. Pain: Effectiveness of pain management
There are some theories of labor - though no theories have been proven scientifically, name three that have to do with hormones ?
1. Progesterone withdrawal 2. Increase release of prostaglandin 3. Increase sensitivity to oxytocin
Four measures to rotate the head
1. hands and knees, rocking pelvis back and forth 2. assist in left lateral position 3. sitting, kneeling or standing while leaning forward 4. squatting
What are some interventions you should do as a nurse when you are inducing labor with Pitocin?
1.Begin electronic fetal monitoring ; Assess FHR and UC 2.Begin primary infusion of IVF 3. Infuse Pitocin into lowest part of primary IV tubing and DILUTE 10 UNITS OF OXYTOCIN IN 1000 ML OF LR INFUSE IN MU/MIN OR ML/HR AS ORDERED 4.Control and titrate on IV pump 5. Progress is determined by dilation, effacement and station change 6. Can result in hyperstimulation, uterine rupture, and fetal hypoxia
Describe how to properly document the fetal presentation using the four imaginary quadrants of the pelvis (i really didnt know how to ask this question)
1st letter -Presenting part tilted towards (L) or (R) side of pelvis 2nd letter -Presenting part of fetus 3rd letter -Location of presenting part in relation to (A), (P), or (T) pelvis
When is the "fertile window" for maxiumum fertility?
3 days before and 3 days after ovulation
What are the cardinal movements of labor??
-Engagement -Descent -Flexion -Internal rotation -Extension -Restitution -Enternal rotation -Expulsion "EVERY DARN FOOL IN ROTTERDAM EATS ROTTEN EGG ROLLS EVERYDAY"
What does the term "floating" mean?
-Engagement has NOT happened -Presenting part is freely moving above the pelvic inlet -The fetal head is directed down towards the pelvis but can still easily move away from the inlet
DepoProvera is an injectable contraceptive - How often should this be injected to ensure adequate birth control is provided?
-Every THREE months (IM Injection)
What is the Fetal Fibronectin Test?
-A test that helps predict the likelihood of a premature delivery within the next 7-14 days -Protein produced by chorion -Acts as a glue, attaching fetal sac to uterine lining -Cannot be detected between 24 and 34 weeks of pregnancy unless there is a disruption -If increasing, can signify labor within 7-14 days
What is a cervial cap and how is it used?
-AKA FemCAP -Similar to a Diaphragm -Used with spermicide
Third stage of laborrrrrr - DESCRIBE
-ALLL about the PLACENTA -From immediately after birth of fetus until the placenta is delivered -PLACENTA NORMALLY SEPARATES WITH 3RD OR 4TH CONTRACTION AFTER FETUS IS BORN -Can take anywhere from 2-30 minutes for placenta to expell -Risk of hemorrhage increases as length of stage increases
Education for Diaphragm and instructions:
-Apply 1 tsp or 1-1/2 in spermicidal on rim and cup -Must feel cervix with fingertip through cup -More spermicide if no sex within 6 hours of placement -Leave in 6 hours after bumpin fuzzies -Clean with mild soap and water; INSPECT FOR HOLES -Refit every 2 years by a professional or if lose/gain 10-15 pounds, and after having a baby
Rupture of membranes (SROM, PROM, or AROM) - Nursing management
-Assess FHR prior (if possible) -Asses FHR after (if Decels, Rule out prolapsed cord) -Assess color, odor, clarity, and volume -DOCUMENT "TACO" -- TIME, AMOUNT, COLOR, ODOR
Explain how to properly correct FHR decelerations?
-Assist with maternal position changes -Apply o2 PRN -Increase fluid intake
Standard Days Method - How would we use this?
-Avoiding unprotected sex on days 8-19 of cycle -Can use CycleBeads to assist -12 day "fertile window"
When does preterm labor occur?
-Before the end of the 37th week of pregnancy
What is going on during STAGE ONE of labor?
-Beings with onset of regular contractions (MILD) -Ends with full dilation of cervix -This stage is longer than stages 2 and 3 -Consists of THREE phases
Fourth stageee - tell me what you know
-Bonding and recovery -Recovery 1-4 hours after delivery -Period of immediate recovery (homeostasis) -Observe for complications (Bleeding)
If you find that there is no progress with the fetus continuing to move down through the pelvis and vaginal canal, what would be your thoughts?
-CPD (Cephalo-pelvic disproportion = inadequately shaped pelvis
When using a sponge, how often can it be left in place?
-Can be left in for multiple coital acts within 24 hours (that seems like it would be sticky?)
What are some conditions for forceps use?
-Cervix completely dilated -ROM, engagement -Vertex or face presentation -Bladder is empty -CPD ruled out
How often should you check the string on an IUD and why?
-Check for the string about every month to ensure that it hasn't migrated
STAGE ONE - TRANSITION PHASE OF LABOR..Describe whats happening during this phase?
-Contractions more frequent, longer, and stronger -More rapid dilation of cervix 8-10 cm -Increased rate of descent of presenting part -RECTAL PRESSURE, low backache -Belching, nausea or vomiting -Beads of perspiration on lip or brow (THINGS ARE GETTING SERIOUSSSS) -Apprehensive, irritable, angry, withdrawn -UC every 1-2 mins, lasting 60-90 sec *** ANYTIME YOUR PATIENT FEELS RECTAL PRESSURE, DO A VAG EXAM***
STAGE ONE- ACTIVE PHASE OF LABOR- whats going on during THIS phase?
-Contractions resume -Dilates 4 cm to 7 cm -Bearing down efforts by woman -Fetal station is advancing -Anxiety increases - employ coping strategies -UC every 2-5 min, lasting 45-60 seconds
How is fetal presentation determined?
-Determined by fetal lie and body part that enters the pelvic passage first -Portion that enters the passage first termed - PRESENTING PART
Endometriosis presentation
-Dull pelvic pain and/or cramping -Dyspareunia (Painful intercourse) -Abnormal uterine bleeding -Heavy/long periods -Painful bowel movements -Painful urination
Explain what a "turtle sign" is
-During shoulder dystocia, the head i born but the shoulder cannot pass under the pubic arch -The fetal chest remains compressed and unable to expand = "turtle sign" **CYANOSIS OF THE FETAL HEAD DUE TO EXCESSIVE INTRAVASCULAR PRESSURE WHICH DEPRIVES BABY OF OXYGEN**
What are some indications for a forceps assisted vaginal birth?
-Threat to mother or fetus -Heart disease -Pulmonary edema, exhaustion
The movement of the passenger is affected by:
-Fetal head (how big it is) -Fetal lie (how fetus laying in mother in comparison to mother's spine) -Fetal attitude (How body part is positioned [[Flexion or extension]] ) -Fetal presentation (Direction coming out how it is turned) -Placenta (Location of placenta - is it blocking anything?)
What is persistent occiput position (POP) and how to manage?
-Fetal mal-position where fetal head is pressing against sacrum and coccyx MANAGEMENT -Use Leopold's Maneuvers
Examples of "Passengers"
-Fetus -Membranes (chorion and amnion) -Placenta
Explain what Cephalo-pelvic disproportion, or CPD is:
-Fetus does not descend -No progression in fetal station -Slow labor and dilation
Most common pelvis is classified as?
-Gynecoid, or female, is most common
Side effects of Epidural/Intrathecal:
-Hot spots -Numbing effect has to wear off, cannot be reversed -Itching -N/V -Urinary retention -Respiratory depression (CAN be reversed with narcan) -Drop in maternal BP and drop in FHR
Epidural - where is it injected? When can you inject? How long does it take to work? Any contraindications?
-Injected into the epidural space (L4-L5 or L5-S1) -Have to be 4 cm dilated -Takes 20-30 mins to work CONTRAINDICATIONS -Cannot be given is there are problems with fetus (drops in FHR) -Can't give if bleeding issues, low platelets, infection/redness at site, or allergy
Stephanie is in labor and her doctor decided that a vacuum extractor needed to be used during birth. What kind of nursing care would you perform during and after birth?
-Keep the family informed -Asessing FHR -REASSURE THAT CAPUT WILL DISAPPEAR IN 3 DAYS -Assess newborn for intracerebral hemorrhage, jaundice
Basal body temp method - What would you be looking for if you were using this method?
-Looking for a drop in temperature before ovulation (below 98F) and rise after (increase of 0.5-1.0F) ***To avoid pregnancy, abstain from intercourse on the day of temperature rise and for 3 days after***
Breech head entrapment - What does this do to APGAR scoring?
-Low 1-minute APGAR scores are NOT uncommon after a vaginal breech delivery -A Pediatrician should be present for the delivery!!
When is emergency contraception, or the "morning after pill", most effective? and what are the methods available in the united states?
-Most effective if used within 72 hours of unprotected intercourse or contraceptive failure METHODS -Plan B One-step -Next Choice -Next Choice One Dose
Hypotonic Uterine Dysfunction
-Normal progress into active labor (at least 4 cm) -Then UC become weak, inefficient -<25 mm Hg or stop completely -Frequency and intensity decrease -Soft uterus **AT RISK FOR MATERNAL BLEEDING**
Intrauterine fetal demise - when can this occur and what are some risk factors?
-Occurs after 20 weeks but before birth RISKS -Multiple gestation -ADVANCED MATERNAL AGE -Rh disease (Rhogam) -Cord accident -Abruption -Trauma -HTN -Substance abuse
Treatment for Face/Brow presentation
-Possible vaginal birth for face presentation -C/S for brow presentation
STAGE ONE - EARLY (LATENT) PHASE of labor - Tell me whats going on during this phase?
-Progressive effacement of cervix -Little increase in descent -Mother is excited and anxious -Cervix dilates 1-3 cm**** -Irregular UCs, every 5-10 min progressing, lasting 30-45 sec; mild intensity
Second stage of labor - explain whats going on!
-Pushing and birthing stage! -Ave 15 min for multiparous (1hour) -Ave 50 min for nulliparous(3hour) -Crowning occurs when birth is imminent -Feeling a sense of purpose -Burning sensation (OUCH)
Nursing management for an emergency delivery...
-STAY CALM!!! -Encourage to push between contractions (less force) -APPLY GENTLE PRESSURE TO PRESENTING PART -Head out - check for nuchal cord -Suction mouth and nose -After delivery, clamp cord, cut cord -Assess and place baby to breast/skin-to-skin
Hypertonic Uterine Dysfunction treatment
-STOP any oxytocin -Rest in left lateral, IV and fluids -Provide meds for rest and uterine contractions -Reduce pain -Encourage rest -Onset of normal labor patterns usually occur after 4-6hours rest period
What is labor dystocia?
-Slow and abnormal progression of labor -Most apparent during 1st stage of labor -Primary cause for C/S delivery -MAIN CAUSE OF CPD "LACK OF PROGRESSIVE CERVICAL DILATION OR LACK OF DESCENT OF FETAL HEAD"
What is the role of a Doula?
-Specialized childbirth support person -Role: enhances comfort and decreases anxiety of a laboring woman -Supports and encourages -Facilitates communication between caregivers -Does NOT aid in nursing staff functions -Increases bonding
Piper forceps assisted delivery of head - what are they?
-Specialized forceps used only for the after-coming head of a breech presentation -Are used to keep the fetal head flexed during extraction of the head
Amniotic Fluid Embolism what is it? How does it present itself? What are some supportive measures/interventions?
-Sudden hypotension, hypoxia, and coagulopathy -Amniotic fluid containing particles of debris enters maternal circulation VIA sit of trauma and obstructs pulmonary vessels -causes respiratory distress and circulatory collapse -50% die in first hour and 85% have permanent neuro damage PRESENTATION -Difficulty breathing -Hypotension -Cyanosis -Uterine atony -Seizures -Tachycardia -DIC -Cardiac Arrest SUPPORTIVE MEASURES/INTERVENTIONS -o2 -IVF -Oxytocic agents -Steriods -Seizure precautions GOALS -Maintain oxygenation -Maintain hemodynamic function -Correct Coagulopathy
How does the Cervical mucus method work?
-The woman determines color/consistency of mucus and charts this -At ovulation, Mucus elasticity increases (AKA SPINNBARKEIT MUCUS) -Mucus becomes abundant, clear, slippery and smooth -Stretch mucus between 2 glass slides or from the vaginal opening (8-10cm or more) Grossssss
Non-pharmacologic methods to pain management
BREATHING TECHNIQUES -Can control pain so mom doesn't need meds -Varies based on preparation -No training, abdominal breathing and pant, pant, blow TOUCH -Effluerage (technique used during facials), soft stroking HYDROTHERAPY -Warm water provides comfort and relaxation AMBULATION/POSITION CHANGES -Enhances maternal comfort ACCUPUNCTURE -Can be effectively used to lower pain during labor HEAT/COLD -Heat helps muscles to relax -Both heat/cold can act as a nerve distractor because it provides a new sensation, which can reduce the perception of pain GUIDED IMAGERY -Focuses on creating harmony between your mind and body in order to ease stress and enhance well-being
A client arrives to the health care facility in the latent phase of labor. Which intervention should the nurse implement? a) Assist in preparation of c/s b) Assist in providing epidural anesthesia c) Provide emotional and physical support d) Administer the drug Naloxone
C) Provide emotional and physical support - during the latent phase of labor, the client is excited and anxious, talkative and eager. It's important to provide the client with emotional and physical support to ensure that all of her needs are met.
Since the pelvis and the cervix accommodate the passage of the fetus, which types of pelvis shapes are favorable for a vaginal birth?
Gynecoid -Female pelvis -Favorable for vaginal birth Anthropoid -Favorable for vaginal birth
You are performing an assessment on your pregnant client. Her fundal height is greater than centimeter measurement and her labs show that her HcG levels are higher than normal. What does this mean?
Multifetal Gestation
FAVD risks to newborn and mother
NEWBORN -ecchymosis and/or edema of face -Lacerations -Caput or cephalhematoma (hyperbilirubinemia) -transient paralysis -cerebral hemorrhage MATERNAL -Lacerations of birth canal -3rd or 4th degree extension of episiotomy -Bleeding, bruising, edema
The fetal movement is affected by the placenta - what are normal and abnormal placental implantations?
NORMAL -Uppermost part of uterus and posterior ABNORMAL -Placenta implanted in lower uterine segment (AKA PLACENTA PREVIA) -May cover the internal cervical OS (Partially or entirely)
Uterine rupture onset and presentation
ONSET -Suddent fetal bradycardia 10-30 min available until fetal morbidity PRESENTATION -ABD tenderness (pain with and without contractions) -Loss of station -SMALL amount of vaginal bleeding (usually internal) -Early signs of shock **PREPARE FOR C/S**
Management of preterm labor
TOCOLYTIC DRUGS -Most likely ordered if labor is before 34 weeks -No fetal distress, abruption, eclampsia, active vaginal bleeding or dilation >6cm -Magnesium sulfate, indocin, tractocile, procardia CORTICOSTEROIDS -Effective in infants born between 24 and 34 weeks -Require at least 24 hours to become effective