Chapter 21: Nursing management of labor and birth at risk

A client has been admitted to the unit for tocolytic therapy. Which medication would the nurse be LEAST likely to administer?

- Corticosteriods rationale: medications most commonly used for tocolysis: magnesium- which relaxes uterine muscle contractions for preterm labor, indomethacin, nifedipine

Air embolism s+s:

- Difficulty breathing, -hypotension -tachycardia

SIGNS OF PRETERM LABOR:

- GI UPSET - ACHINESS IN THE THIGHS -LOW, DULL BACKACHE -GENERAL SENSE OF DISCOMFORT

a nurse is teaching a 42 week nulliparous pregnant woman about labor induction which is being recommended by her health care provider. The nurse determines that the woman needs ADDITIONAL teach when she identifies which assessment as being done before induction?

- Leopold position rationale: before labor induction is started, fetal maturity (dating, ultrasound, amniotic fluid studies) and cervical readiness (vaginal examination, bishop scoring)

Prolonged pregnancy risk to fetus

- Macrosomia, shoulder dystocia, lowapgar scores

Oral tocolytic therapy

- Nifedipine and indomethacin MAG IS GIVEN IV ONLY

There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication?

- Reduced oxygen to the fetus

After assessing a clients progress of labor, the nurse suspects the fetus is in a persistent posterior position. Which finding would lead the nurse to suspect this condition?

- Reports of severe back pain are associated with a persistent occiput posterior position

Diagnostic test for preterm labor risk assessment?

- Transvaginal ultrasound -Fetal fibronectin testing -salivary estriol levels NOT BLOOD CHEMISTRY

A woman in labor is receiving oxytocin. Which effect would the nurse need to be alert for potentially occurring?

- Water intoxication rationale: oxytocin can lead to water intoxication and can cause hypotension

A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate?

-STOP THE INFUSION IMMEDIATELY Rationale: The woman is exhibiting signs of uterine hyper stimulation, which necessitate stopping the oxytocin infusion immediately to prevent further complications.

oxytocin can cause

-water intoxication and hypotension

Typical rule for monitoring labor progress.

CERVICAL DILATES 1 CM PER HOUR!

Dinoprostone

Is approved by the FDA as the only cervical ripening agent to be used contraindicated in women with prior uterine scars.

Protracted disorders:

Refers to a series of events including protracted active phase dilation (slower than normal rate of cervical dilation) and protracted descent (delayed descent of the fetal head in the active phase). Diagnostic criteria are 1.2 cm per hour for primips and 1.5 cm per hour for multips. For protracted descent, the criteria are less than 1.0 cm per hour in primips and less than 2.0 cm per hour for multips.

In preparing the client for this therapy, the nurse anticipates that the clients pregnancy may be prolonged for how long when this therapy is used?

Tocolytic drugs may prolong the pregnancy for 2-7 days.

Bishop score

a bishop score less Than 6 indicate that a cervical ripening method should be used before labor induction