Nur 106 Module C part 2

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What is the mechanical method for the Bishop Score

-Foli tip is placed in -inflate the balloon with Normal Saline -nurse tugs on it, which puts pressure on the cervix -when it eventually falls out, the pt is probably 3 cm

What are some interventions when a baby is breeched

-IV fluids are given -cover the abdomen with ultrasound jell -manually move baby

Risks for inductions

-Tachysystole uterine activity -uterine rupture -maternal water intoxication -chorioamnionitis -increase risk for c-section

What are things that need to be assessed in the active phase

-VS -cervix dilation -effacement -fetal monitor

What are some discomforts during the fourth stage of labor

-after birth pains -perineal discomforts

Nursing considerations for insufficient Bishop Score

-all consents signed -20-30 min. FHR baseline -IV access -Have pt empty their bladder -recumbent position for the first 30 min. -monitor continuously

Fetal Causes of dysfunctional labor

-anomalies -Cephalopelvic Disproportion (CPD) -Malposition -Multifetal pregnancy

The variables affecting labor: Psychological response

-anxiety -birth as and experience -support system

What are some risk factors for a breeched baby while being turned

-baby could get tangled up with the cord -abruption -irritates uterus

What are some non-pharmacologic interventions for pain control

-birthing ball -changing positions -walking around -the environment -thermal stimulation -acupressure -breathing techniques

Nursing considerations during infusion of Pitosin

-continuously assess FHR and contraction activity -decrease/discontinue for non-reassuring FHR pattern and/or tachysystole - may need to reduce the rate of infusion when in active labor (5-6 cm)

Pitocin: Maternal Assessment

-contraction pattern and uterine tone -VS and pain every 15-30 min. or with each dose change -strict I&O's for water intoxication

What are some true signs of labor

-contractions -discomfort -the cervix begins to dilate -the head begins to show

Nursing Considerations for Cytotec

-don't administer to pt's with uterine surgery -pharmacy has to prepare -continuous fetal monitoring -Pitocin may be administered 4 hrs. after last dose

What effect do pharmacologic management have on complications

-failure to progress -decrease BP -decrease FHR -illicit drug use

Prolonged labor

-greater than 18-24 hrs. -meds such as epidural -positioning (if mom's not changing positions)

Prolapsed Umbilical cord causes

-high station -small fetus -breech presentation -transverse lie -polyhydramnios

Nursing Interventions: non-reassuring (abnormal) FHR patterns

-identify cause -stop/reduce oxytocin -reposition -increase IV fluids -O2 by face mask -Vag. exams -VS -notify HCP

What are some adverse effects of excessive pain

-increase in uterine resting tone -reduces effectiveness of contractions -reduces blood flow to and from the placenta

What are some indications of an induced labor?

-intrauterine environment hostile to fetus -SROM at or near term -postterm -chorioamnionitis -hypertension -mild abruption -maternal conditions (diabetes, renal, heart,or pulmonary disease) -fetal death

If a pt has a classical incision, what can't the mom do?

-labor and vag. birth -can't be induced

What are the 3 phases in the first stage

-latent (early) -active -transitional

What are factors to consider in the second stage of labor

-maternal position and efforts -fetal size

What are some false signs of labor

-no head -thick cervix -irregular contractions

Contraindications that may need to be re-thought for inducing labor

-one or more previous low transverse c-section deliveries -breech presentation -over distention of the uterus -severe hypertension -fetal presenting part above the pelvic inlet -nonreassuring FHR patterns

Safety measure for Pitocin

-piggyback into primary lime at port closest to site -side-lying position to promote uterine blood flow -continuously assess FHR and uterine contractions

Intrapartum Emergencies

-placenta abnormalities (preveas and abruptions) -prolapsed umbilical cord -uterine rupture (previous uterine surgery) -uterine inversion

Contraindications for induced labor

-placenta previa or vasa previa -prolapsed umbilical cord -abnormal fetal presentation -active genital herpes -presenting part above the pelvic inlet -previous surgery on upper uterine segment -labor shouldn't be induces if the fetus is younger than 39 wks gestation unless a compelling reason exists

Intrapartum Complications

-possible intrauterine infection (fever) -Postterm pregnancy (beyond 42 wks)

What are risk of an amniotomy

-prolapse of the umbilical cord -infection -abruptio placentae

Uterine inversion causes

-pulling on cord -fundal pressure -placenta adherence -weak uterine wall

Nursing Considerations for Cervidil

-remove after 12 hr or w/ onset of labor or ROM -pt teaching -continuous fetal monitoring -may begin Pitocin 30-60 min. after removal

What are interventions for any pain medications (epidural and spinal block)

-reposition -increase IV fluids -Ephedrine -administer O2 -assess for fetal distress

Before turning off Pitocin what should the nurse do (interventions)

-repostion -give fluid bolus -give O2

Oxytocin (Pitocin)

-stimulates contractions -always given w/ an infusion pump -never given by gravity due to perfusion by gravity -starts w/ 1 ml/hr and then increases

Signs of Prolapsed Umbilical Cord

-sustained fetal bradycardia -variable deceleration

Dinoprostone (Cervidil)

-used as cervical ripening -has a 12 hr time release - can be removed (has a string attachment) -expensive

Misoprostol (Cytotec)

-used for induction -used to soften cervix -uterus contracts with high doses -can't be removed

Positions for prolapsed umbilical cord

-woman's hips higher than head to shift fetal presenting part toward the diaphragm -knee to chest (lets baby fall back into the abdomen and relieves pressure) -trendelenburge -vag. evaluation of the presenting part

how much is the women dilated in the latent phase

0-3 cm

After an amniotomy, how long does a nurse monitor the FHR for?

1 full minute

how long could the transitional phase last

1-2 hrs

how long does a spinal block last

2 hrs

how long could the latent phase last?

24 hrs

Predipitous labor

3hrs or less

how much is the women dilated in the active phase

4-7 cm

What scoring would be given if the cervix isn't ready (Bishop Score)

6 or less

how much is the women dilated in the transitional phase

8-10 cm

When do Braxton Hicks contractions occur?

@ 20 wks

What category is: Accelerations

Category 1 (reassuring)

What category is: Fetal heart rate baseline 140

Category 1 (reassuring)

What category is: Three accelerations in a 10 minute period

Category 1 (reassuring)

What category is: moderate variability

Category 1 (reassuring)

What category is: recovery to baseline following maternal position change

Category 1 (reassuring)

What category is: A positive CST

Category 2 (non-reassuring)

What category is: Baseline 135 with absent varibility

Category 2 (non-reassuring)

What category is: Baseline 180

Category 2 (non-reassuring)

What category is: Late deceleration with moderate variability

Category 2 (non-reassuring)

What category is: Late decelerations

Category 2 (non-reassuring)

What category is: Minimal or marked baseline variability

Category 2 (non-reassuring)

What category is: Tachycardia with absent variability

Category 2 (non-reassuring)

What category is: early deceleration with minimal variability

Category 2 (non-reassuring)

What category is: prolonged decelerations

Category 2 (non-reassuring)

What category is: Recurrent late deceleration with absent variability

Category 3 (non-reassuring)

What category is: Variable deceleration with absent variability

Category 3 (non-reassuring)

What are things to look at for a focused assessment on admission

FHR and maternal VS

If medications are given for a low scoring Bishop Score what needs to happen (r/t monitoring)

Fetal heart monitor need to be put on

What is the resting tone of a contraction?

It is the resting point after a contraction

What maneuver would be used to determine where a monitor goes for a baby?

Leopold's Maneuver

What is McRobert's Maneuver?

Mom's legs are pulled back as far as possible to open up the pelvis

What type of diet is a pt on when having a c-section

NPO

In the transitional phase, what can women not be given

No medication

What medication would NOT be given if the Bishop Score was a 6 or less

Oxytocin

What is the first stage of labor called

The stage of cervical dilation

Doctors put a standing order for what medication? and what does it do?

Tubertaline (Brethine), it given if there is too many contractions

What does the station of the baby tell a nurse?

Where the baby's head is sitting in relation to mom's pelvis

If a shoulder dystocia cannot be corrected, what can happen?

a C-section may be performed

Ruptured uterus is what

a medical emergancy

A pt has a classical incision, what will she not be able to do?

a pt can't do a vag delivery or labor

Variable deceleration are which of the following: -gradual -abrupt -periodic -episodic

abrupt and episodic

A (VEAL CHOP)

acceleration

The primary goal of intrapartum fetal surveillance is to enable clinicians to asses what?

adequacy of fetal oxygenation during labor

The third stage of labor begins immediately

after the fetus is born and ends when the placenta is delivered

What is the key to recovery?

ambulation (movement)

What type of medication should be given if a pt has Polynefritus

antibiotics

A (PAIN)

anticipated

Amniotomy

artificial rupture of membranes and it allows for more pressure and it allows for the cervix to dilate more

A (MAD) (active phase)

assess and anticipate physical needs

Signs of uterine inversion

bleeding, toned up

How is Cytotec administered?

can be taken by mouth or placed near the cervix

What type of diet is a pt on when having a vaginal delivery

clear liquid diet

After an amniotomy what should bedocumented

color clarity amount odor time VS

The second stage of labor begins with

complete cervical dilation and ends with delivery of fetus

Pitocin: Fetal Assessment

continuously or intermittent fetal heart tracing (document q 5-30 min.)

During the second stage of labor the pt should push along with what?

contractions

C (VEAL CHOP)

cord compression

What is the most common cause of fetal insufficiency?

cord compression

Signs and symptoms for Cytotec

cramping and bleeding for 24 hrs

Shoulder Dystocia

delayed or difficult birth of the fetal shoulders after the head is born

D (TIRED) (transitional phase)

discomfort

D (MAD) (active phase)

dry lips and dry linens

When does lightening occur in pregnancy?

during early labor

E (VEAL CHOP)

early

What type of deceleration is this: due to head compression

early

What type of deceleration is this: early onset

early

What type of deceleration is this: Uniform shape

early and late

What type of deceleration is this: usually within normal heart range

early and late

E (TIRED) (transitional phase)

encourage/ praise

The variables affecting labor: Passenger

fetal head, variations on the passager position

What can cause the fundus to be inverted (uterine inversion)

firm massage pressure

When is a spinal block most commonly use

for a scheduled c-section

What does a nurse need to look at when a contraction happens?

frequency, duration, and resting tone

Where are Braxton Hicks felt?

from the sides

Where are real contractions felt?

from the top of the uterus

Early deceleration are which of the following: -gradual -abrupt -periodic -episodic

gradual and periodic

Late deceleration are which of the following: -gradual -abrupt -periodic -episodic

gradual and periodic

What scoring would indicate that the cervix is soft and ready, using the Bishop Score

greater than 7-9

H (VEAL CHOP)

head compression

Continue to give Pitocin after birth to prevent what

hemorrhage

Both prolonged and prefipitous labor are at an increased risk for what?

hemorrhages

what can placenta complications could lead to?

hysterectomy

With an amniotomy what is the mother at an increase risk for

infection

After 18 hrs ago, a ROM is performed and mom is in active labor, what is she at an increase risk for and what are nurses worried about

infection and sepsis

I (TIRED) (transitional phase)

informed progress

I (PAIN)

intermittent

What happens to a pt's BP when given a spinal block

it decreases

How does local infiltration anesthesia work

it numbs the perineal area for any laccerations

L (VEAL CHOP)

late

What type of deceleration is this: Late onset

late

What type of deceleration is this: due to uteroplacental insufficiency

late

What type of deceleration is this: may be altered with maternal

late and variable

What type of deceleration is this: may be associated with fetal acidosis

late and variable

What is given in a pudendal block?

lidocane

What are some risk factors when dealing with and epidural or spinal block

maternal hypotension bladder distention (empty bladder)

M (MAD) (active phase)

medication

Cephalopelvic Disproportion (CPD)

mom's pelvis and baby's head do not match

Tachysystole

more than 5 contractions in 10 minutes

Which intervention by mom is most important during the active phase?

movement

An increase secretion of ______________ __________________, can also stimulate the laboring process

natural oxytocin

What is phenergan used for

nausea

N (PAIN)

normal

O (VEAL CHOP)

okay

Where would a nurse put a monitor on a fetus?

on the fetus's back

What is the most common adjunctive drug

phenergan

When contractions are going well, but they are not strong enough, what is the pt given

pitocin

P (VEAL CHOP)

placenta insufficiency

P (PAIN)

purposeful

How often does a nurse take a temperature after an amniotomy

q1-2 hrs.

what is the length and duration of contractions in the transitional phase

q2-3 min. and for 45-90 sec. duration

what is the length and duration of contractions in the active phase?

q3-5 min. and for 30-60 sec. duration

Bishop Score

ratings of the readiness of the cervix

R (TIRED) (transitional phase)

restless

Applying suprapubic pressure allows for what (in shoulder dystocia)

rolls the shoulder in -may cause fractured clavicle or humerus fracture

During the transitional phase, what is one thing the nurse needs to teach?

short, panting breaths

Pitocin is given to do what?

speed up the contractions

What 2 systems are responsible for "fight or flight"?

sympathetic and paprasympathetic

A pt can get _______________ when pitocin is given

tachysystole

Who does general anesthesia most affect

the baby

Braxton Hicks do not change what

the cervix

Cervical ripening is a sign for what

the cervix is changing to become softer, and the dilation process starts

the fourth stage of labor begins after

the delivery of the placenta and continues for 1-4 hrs after delivery

If anything happens to mom, what should a nurse assess

the fetal heart rate

If the mom does not have adequate blood flow, what will happen to the fetus?

the fetus won't be perfused well

Prostaglandins stimulate what

the laboring process

The stage of cervical dilation begins with:

the onset of regular contractions and ends with complete dilation

What is the third phase of labor called

the placental stage

With an epidural, a pt should still fill....

the pressure of the baby

Management of prolapsed umbilical cord

the priority is to relieve pressure on the umbilical cord to improve blood flow through it until deliver

Variables are common during which stage in labor?

the pushing stage

What is the fourth stage of labor called

the recovery stage/ maternal homeostatic stabilization stage

Cervical Ripening

the softening of the cervix

What is the second stage of labor called

the stage of expulsion

effacement

the thickness of the cervix

Systemic drugs for labor act on what

the whole nervous system

What are some maternal behaviors of the fourth stage of labor

tired and excited

T (TIRED) (transitional phase)

tires

What is the purpose of using Ephedrine after an epidural

to bring up BP

polyhydramnios

too much amniotic fluid

Hypo/hypertonic uterine dysfunction

too much or too little contractions

The variables affecting labor: Passage

true pelvis is most important

If pt is contracting well what should the nurse do if pt is on pitocin

turn pitocin down

The variable affecting labor: Powers (what is needed)

uterine contractions and maternal pushing efforts

Fight or flight is how you get what?

variability

V (VEAL CHOP)

variable

What type of deceleration is this: due to cord compression

variable

What type of deceleration is this: variable onset

variable

What is engagement

when the baby drops into the pelvis, and happens during active labor

lightning

when the baby falls in the pelvic area, and the mom can finally breath again

When is a version not done

with PTL

Can a pt develop kidney stones when pregnant

yes


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