Intrapartum Complication (8 questions)
magnesium sulfate Magnesium sulfate is only given intravenously for preterm labor. Nifedipine and indomethacin are given orally for preterm labor. Betamethasone is given by intramuscular injection to help promote fetal lung maturity by stimulating surfactant production. It is not a tocolytic agent.
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? magnesium sulfate nifedipine indomethacin betamethasone
less than 3 hours
How long does a precipitate labor last?
Dim lighting Comfortable environment
Intervention for psyche dysfuntical labor?
1. Stop Labor 2. Limit Activity ( relax, side lying) 3. Hydration 4. Tocolytics - to delay labor long enough to initiate corticosteroids therapy) 5. Accelerating fetal lung maturity - corticosteroids/ reduce reparatory distress syndrome
Interventions for preterm labor
Terbutaline (Brethine)
Medication that relax uterine smooth muscle to inhibit uterine activity. You have to monitor for CV side effects.
Indomethacin (Indocin)
NSAID. medication that inhibits prostaglandin synthesis- decrease uterine contractions.
1. Intervene immediately (due to cord compression) 2. McRoberts position/ Suprapubic pressure 3. Squatting/ Hand to knees (too free the shoulders) 4. Do not apply fundal pressure
What are intervention shoulder dystocia?
Pelvis - too small or abnormal Soft Tissue - bladder distension
What are problems associated with passage?
Fetal size (macrosomia) Fetal Position Fetal Anolimes Multi fetal
What are problems associated with passenger?
Fetal: Sudden fetal distress Maternal: Abdominal pain Chest Pain Hypovolemic shock
What are signs of uterine rupture?
Prepare for C section Monitor for tachycardia/ hypotension for hypovolemic shock
What are the interventions for uterine rupture?
Ineffective maternal pushing ( fear, exhaustion) Ineffective contractions (hypertonic, hypotonic, uterine distention)
What are the problems associated with powers?
Ruptured membranes Hydraminos Abnormal presentation High station
What are the risk for umbilical cord prolapse?
C section
What intervention would you do for a person with cephalopelvic disproportion?
turtle sign
What is another name for shoulder dystocia?
24-34 weeks
What is the indication for cortisteriods?
Increase birth weight
What is the most common cause of shoulder dystocia?
relieve pressure off the cord
What is the primary intervention for umbilical cord prolapse?
Fetal complications such as: Intracranial pressure Hypoxia Nerve damage
What is the priority action after a precipitate labor?
Assess brachial plexus (assess for nerve damage)
What is the priority after birth with shoulder dystocia?
Prompt delivery
What is the priority for umbilical prolapse?
cortisteriods
What kind of medication is bethamasome?
Put her to bed immediately call for help relieve pressure off cord
What should you do if you see the patient cord hanging out?
late decelerations
What would you see on a fetal heart monitor if the mom had a uterine rupture?
calcium gluconate
Which medication do you want to have on hand for magnesium toxicity?
c) Uterine rupture A falling blood pressure and increasing pulse is a sign of hemorrhage and in this patient a uterine rupture needs to be a first consideration.
While in labor a woman with a prior history of cesarean birth complains of light-headedness and dizziness. The nurse assesses the patient and notes an increase in pulse and decrease in blood pressure from the vital signs 15 minutes prior. What might the nurse consider as a possible cause for the symptoms? a) Umbilical cord compression b) Hypertonic uterus c) Uterine rupture d) Placentea previa
Nifidipine (Procardia)
medication that reduce muscle contraction. also a calcium channel blocker
Magnesium Sulfate
medication that slows uterine activity
Tocolytic
medication to delay birth to term.
Bethamesome
this medication is for fetal lung maturity
problems with the fetus problems with the uterus
A nursing student correctly identifies the causes of labor dysfunction to include which factors? Select all that apply.
2 to 7 days
A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? 2 to 7 days 1 to 5 days 6 to 10 days 4 to 8 days
macrosomia Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection.
A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? hemorrhage macrosomia infection dystocia
brachial plexus assessment
A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth?
Assess fetal heart sounds.
A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client?
Assist with maneuvers. Keep time. Document events in the record. Lower the head of the bed. . The head of the bed needs to be lowered to a flat position to increase the effectiveness of McRoberts maneuver and to give the health care provider the maximum space to birth the shoulders
During a shoulder dystocia emergency, what action(s) does the nurse implement to prevent fetal hypoxia? Select all that apply. Assist with maneuvers. Keep time. Document events in the record. Lower the head of the bed. Administer oxytocin to increase the contractions.
Diabetic mother Obesity Macrosomia Short stature (small pelvis)
What are causes of shoulder dystocia?
